J. Barben

Advanced Epithelial Ovarian Cancer: Have We Really Improved Care for Patients Aged 70 Years and Older? A 20-year Registry-based Study

Advanced epithelial ovarian cancer (aEOC, International Federation of Gynecology and Obstetrics(FIGO) stages IIIC-IV) is the most frequently diagnosed and lethal form of ovarian cancer. The aim of this study was to evaluate net survival (NS) over time and the differences between younger (<70 years) and older (≥70 years) patients (OPs). All patients with aEOC diagnosed in the French department of Côte d'Or between 01 January 1998 and 31 December 2018 were included. Two-year and 5-year NS were calculated for the two age groups over three periods: 1998 to 2004 (T1), 2005 to 2011 (T2), and 2012 to 2018 (T3). A total of 392 patients were included, of whom 154 (39.3%) were aged ≥70 years. Surgery-based treatment was used less frequently in OPs (58.15% vs 83.41%, P < 0.0001) and decreased over time, notably in OPs (74.2% at T1 vs 34.8% at T3, P < 0.001). There was a clear increase in chemotherapy alone at T3 vs T1 in OPs (odds ratio = 8.14, 95% confidence interval [CI]: [2.49-26.58], P < 0.001). The 5-year NS was lower in OPs (23.3%, 95% CI: [17.1-31.8] vs 44.6%, 95% CI: [38.7%-51.6%], P < 0.001) over the 20-year period. The only significant difference in NS between patients aged ≥70 years and <70 years was observed during T3, 17.9% (95% CI: [10.9-29.5]) vs 42.9% (95% CI: [33.8-54.4], P < 0.001) for 5-year NS. NS for aEOC was lower in women aged ≥70 years, especially from 2012 to 2018. Nonoptimal treatment was also more frequent in the older age group.

The challenge of ovarian cancer care in the oldest old

Ovarian cancer (OC) is the eighth most common cancer in women, with a poor prognosis, particularly in older women. The aim of this study was to describe an octogenarian population with OC and to examine the differences in net survival (NS) according to age. In this retrospective observational population-based study from a gynecological cancer registry, patients aged > 18 years with an identified epithelial ovarian cancer stage IA to IVB diagnosed between 1998 and 2018 were included. Patients with non-available FIGO stage were excluded. Patients were stratified into three age groups: <70, 70-79 and ≥80 years, then by OC stage (FIGO I-II, IIIA-IIIB, IIIC-IV). Sociodemographic and cancer-related variables were compared using univariate test (Khi²). The 5-year NS was calculated using the Pohar-Perme method. Among the 721 patients included: 462 (64.1 %) were younger than 70 years, 176 (24.4 %) were aged between 70 and 79 years, and 83 (11.85 %) were aged 80 years or older. Patients ≥80 years had a trend for lower rate of serous carcinoma than the other age subgroups. As age increased, patients were less likely to undergo surgery and chemotherapy. While 73 % of women <70 years received a combination of surgery and chemotherapy, the rate was 62 % among women 70-79 years and 27 % among women ≥80 years (p<.0001). When focusing on FIGO IIIC-IV stages, the 5-year NS rate for women <70 years was 45.1 % (95 % CI 39.1-52.0). For women 70-79 years, it was 25.9 % (95 % CI 18.6-36.1), and for those ≥80 years, it was 19.5 % (95 % CI 10.0-38.0) (p<.005). The oldest patients had less optimal treatment and a lower NS compared to patients in their seventies or younger. Frailty should be carefully assessed to optimize care in the oldest patients with OC.